In this session from the 12th Annual Update Course in Pediatric Surgery, Dr. Margaret Mutch from Australia walks through the complexities of chest wall reconstruction following thoracic osteosarcoma resection in a pediatric patient.

Key Highlights:

• Massive resection and reconstruction: A 14-year-old patient underwent an aggressive en bloc resection involving ribs 4–7 and vertebral bodies T4–T7. The team used a combination of resorbable molded plates, Permacol mesh, and Gore-Tex patches to stabilize and recreate the chest wall structure.

• Soft tissue closure with latissimus flap: A latissimus dorsi flap was mobilized for robust coverage, reducing dead space and supporting tissue healing over the reconstructed area.

• Use of ROLL technique for lymph node excision: The team employed radio-guided occult lesion localization (ROLL) using Technetium-99 to precisely identify and remove targeted lymph nodes.

• Managing early complications: Postoperative challenges included sterile seromas, a wound infection, and mild scoliosis—all managed conservatively with good outcomes.

• Addressing recurrence and reoperation: When local recurrence occurred 18 months later, a second reconstruction involving the sternum and cement mesh was required, illustrating the long-term complexity of these cases.

• Future outlook for pediatric reconstructions: Dr. Mutch emphasized the lack of standardization in pediatric materials and techniques, pointing toward a future where custom 3D-printed implants and biologics may offer better long-term solutions.

This session highlights the surgical precision, interdisciplinary coordination, and resilience required to manage large-scale reconstructions in growing children—where both oncologic control and functional outcomes must be balanced.